cnr-itbride workshop, brussels 2006-12-08 policies and roadmaps for semantic interoperability in the...

CNR-ITB RIDE Workshop, Brussels 2006-12-08

Policies and Roadmaps for semantic interoperability

in the eHealth domain

Angelo Rossi Mori, eHealth Unit, CNR-ITB


Policies and roadmapsGOAL:To develop a Roadmap for semantic interoperability for future research and development activities in the context of the eHealth action plan

Communication COM (2004) 356, “eHealth – Making Healthcare Better for European Citizens: An Action Plan for a European e-Health Area”.

to compare the strategies in different jurisdictions, to explore their construction and their limitations, to work out the principles for the development

of a roadmap


disciplined vs. fuzzy environmentsdisciplined environments diagnostic services (orders and reports),

booking, admission, discharge letter, … systematic interactions, stable workflows inter-operability, standard messages

fuzzy environments human co-operation, clinical communication clinical pathways, datasets, narrative co-operability, document-based approach


main principlesuccessful ICT solutions should correspond to perceived

communication needs of clinicians and citizens,

rely on clear workflows,

be supported by systemic actionsby healthcare managersand by adequate policies


IC (T) ?more emphasis on

I nformationC ommunication

less emphasis on T echnology

the context for semantic interoperability what are the interactions ? how far are they systematic ?


1. Policies and strategiesa. comparative analysis of strategies in

different jurisdictionsb. exploration of limitations of the current

policies and strategies c. role of non-technological factorsd. criteria for roadmap design preliminary activity:

set up an Explanatory Framework


1a. analysis of strategies comparative analysis of strategies

in different jurisdictions, e.g. : NPfIT in England, ONCHIT in US (and the RHIOs phenomenon) Infoway in Canada, OpenConnect in Australia

+ existing RIDE material+ partners' contributions …


1b. limitations of current policies identify the limitations

of the current policies and strategies: What was wrong with the process so far ? How to improve the effectiveness of

deployment? How to obtain “a realistic approach and

applicability in clinical settings”?


1c. non-technological factors regulations, education, economics, involvement of stakeholders, role of public agencies to support the

deployment and the research, ways to involve the research community


1d. criteria for roadmap design criteria and metrics as an input

to the roadmapping process to satisfy the EU eHealth Action Plan on the deployment; on the processes of change management; on the potential role of authorities


+ Explanatory Framework work out a common language

to describe policies and strategies a preliminary activity to systematize:

the driving factors for eHealth evolution the evolution of eHealth solutions the layers of interventions

(as an adaptation of the ongoing activities within the eHealth ERA Projectand the EU Stakeholders' Group)


four layers of interventions L1. basic tools and services to enable other layers

hw, sw, networks, regulations, identification L2. to improve efficiency of operational workflows

booking, prescribing, reporting, ...(message formats, terminologies)

L3. to improve quality of shared care synergy of actors, patient empowerment

(clinical pathways, data sets) L4. to improve governance of healthcare system

structural actions (indicators)


L1. basic tools and services to enable upper layers Various large jurisdictions are envisaging national

(federal) and regional programmes, to develop coherent inter-sectoral infrastructures (e.g. by eGovernment actions and generic standard, e.g. HTML, XML) and health-specific infrastructures.

In parallel, there is an increasing attention to define and adopt regulations and standards, and to make plans for specific educational activities for the public and healthcare professionals.


L1. basic tools and services to enable upper layers build the technological infrastructure; set up the proper regulatory framework,

including connectivity, security, privacy; produce or adopt standards and reference

material to achieve semantic interoperability;

set up a certification process on quality and safety of eHealth solutions


L2. to improve efficiency of operational workflows to improve speed, quality, quantity of procedures

performed with a given amount of resources. stereotypical situations (e.g. on prescriptions,

discharge letters, test reports, …) were the topic for intense activities on interoperability standards in last 15 years

largely independent from the actual patients conditions: most of them do not influence appropriateness of procedures and clinical decisions, i.e., the intrinsic nature of healthcare services is not altered


L2. to improve efficiency of operational workflows provide services to improve the current

workflow-oriented services provide a basic electronic assistance to

clinicians and managers provide support to Public Health Systems,

on epidemiology, management and planning (derived usage of information).


L3. to improve quality of shared carerationalisation of the processes

of care provision by a problem-oriented perspective:

support the daily clinical decisions of multiple healthcare professionals and a more effective behaviour of patients and clinicians

with the capture, storage and transmission of specific data items, depending on the particular context within the care plan


L3. to improve quality of shared care advanced services on information and

knowledge for clinicians services for the empowerment of health

consumers: citizens, patients, their families and caregivers

programs supporting the current care processes


L4. to improve governance of healthcare system information support

to discover bottlenecks to negotiate among stakeholders to decide for systemic actions

more effective management of services and refinement of medium- and long- term policies, by the analysis of accurate and timely data, directly taken from the routine care processes of each individual patient

increase in quality and better control on resources (appropriateness).


L4. to improve governance of healthcare system re-engineering care processes

structural actions on the healthcare system to increase quality and appropriateness of care provision

enabling innovative organisational models production and evaluation

of eHealth roadmaps support change management processes

for eHealth deployment


L3 - CLINICALLY-ORIENTED PROCESSESchronic elderly children patient etc care empowerment .

four layers of interventions

prescribing booking reports managerial EIS etc

L2 - OPERATIONAL WORKFLOWS

L1 – ENABLINGINFRASTRUCTURE

- standards, certification . .

- privacy, security . . . . . . .

- portals . . . . . . . . . . . . . . .

- document sharing, EHR .

- etc . . . . . . . . . . . . . . . . . .

L4 – GOVERNANCEstructural actions

on the healthcare systemdriven by healthcare managers

including eHealth roadmaps, by authorities, alliances

competence centres


eHealth evolution: driving factors

gradual evolution of ICT market in healthcare

eHealth roadmaps (on deployment and research)

modernisation of healthcare processes

supported by ICT solutions

inter-sectoral activitiestowards Information Society(e.g. eGovernment plans)

L1

L2

L3L4


eHealth asks for new drivers increasing role

of regional / national authorities(ministries of health and innovation) roadmaps infrastructures and regulations

shift of attention from technological issues (market) to governance and organisation

of the healthcare system


Roadmaps1. develop specific roadmapping principles

a. criteria to pass from policies to actionsb. reference taxonomy on roadmapping actionsc. metrics to select and prioritize actions

2. for each sub-domain, work out:a. tables of preconditionsb. business implementation pathsc. concrete research tasks

3. synopsis and recommendations


1a. from policies to actions to work out the possible consequences

of selected policy objectives: from the policy issues

to potential specific goals to systemic actions on the healthcare milieu

to the involved semantic issues next steps:

work out the corresponding actions to promote semantic interoperability


policy issue 1 - safer decisions, quality of care processes increase influence

on medical errors and on patient's errors, by timely providing adequate knowledge to assist proper decisions

increase the quality of care processes, i.e. declaring and following explicit reference clinical pathways

increase the mutual awareness of what other clinicians are knowing, doing or planning on the patient


influence on errors goal - avoid errors

e-prescribing (producing the prescription) database on potential drug interactions, adverse

reactions (formulary) assist patient in performing procedures

instructions to patients (multi-cultural, multi-channel)


influence on decisions goal - leverage authoritative clinical

knowledge for clinicians assure quality of routine care provision

reference clinical pathways decision support

assisted access to authoritative knowledge


influence on information sharing goal - effectively manage unexpected

contacts (patient mobility) emergency patients, not able to

effectively present their history emergency data set, special needs, problems maintained lists

(active problems, allergies, ongoing medications) incidental access, without a shared plan

(GP and hospital, second opinion) basic patient profile, problem-oriented profile


policy issue 2 – sustainable evolution of healthcare the increasing cost of healthcare requires

a rationalisation of services provided, without a negative effect on quality of care. continuity of care, patient empowerment accurate governance based on

routine clinical data and suitable indicators, to produce benchmarks and to allow self-assessment of healthcare professionals


role of ICT solutions vs. the evolution of healthcare sectorgoing towards the upper layers, technological factors become less relevant semantic interoperability is more crucial the major goal becomes the governance

for a sustainable evolution of the healthcare sector

driving forces are shifting from market and ministries of innovation to clinicians and ministries of health


influence on care models goal – support new care models: disease

management, long term care support to chronic conditions, frail elderly control of remote devices (home care), support to care managers

patient's folder, problem-oriented profile, context-specific data sets


influence on care fragmentation goal - face fragmentation of care provision

planned shared care, with multiple professionals (continuity of care)

shared clinical pathways, cooperative shared plans, context-specific data sets

sharing any type of electronic clinical document (according to any format)

referral letter to pass care mandates between professionals

avoid duplicated tests repository of test results


influence on patient behaviour goal - patient empowerment

adequate impact on lifestyle and on compliance to therapy

recalls, alerts, reminders clinical knowledge for patients (multi-channel) Patient Health Record (PHR) clinical pathways and health balance

patient self-assessment, appropriate requests for healthcare facilities / services

simple flow-charts to guide patient's access to appropriate facilities


influence on governance goal – improve governance and quality

timely information on healthcare processes and outcomes

datawarehouse and indicators of process and outcome

registries for management and epidemiology


policy issue 3 – improve access to services

simplification of the paperwork rationalisation of organisational and

administrative processes increase of efficiency of operational workflows

(e.g. prescriptions, booking, reports, …). effective portals, with practical information

and authoritative clinical knowledge


influence on efficiency goal – increase efficiency, avoid burden

operational workflows e.g. booking, reminders, prescriptions, reports

continuity over time, maintain history across episodes

immunisations, derived lists (e.g. tests, events, treatments, prescriptions)

simplify administrative processes registration data, e.g. insurance, preferred GP,

exemptions from payments, enrolment in programs (e.g. home care, dialysis, …)


influence on appropriate access goal – select the most appropriate

point-of-service (improve patient choice) make information about services more

accessible citizen's portal (multi-cultural, multi-channel),

yellow pages about available healthcare services and facilities

patient self-assessment, appropriate requests for healthcare facilities / services

simple flow-charts to guide patient's access to appropriate facilities


influence on availability goal – extend availability of healthcare

services primary care centre,

on-call physician, out-of-hours, patients shared among a group of GPs

extended patient profile, sharing the local EPRs


1b. reference taxonomy we developed a reference taxonomy

expanding the four layers of interventionspotentially involved in a roadmap

the topics enumerated in the taxonomy should be interpreted only as an interlingua to reach an uniform representation of the activities described by the countries, not as a proposal for the actual decisions on the Roadmaps that are actually taken within each jurisdiction


1c. metrics to select and prioritize actions develop criteria to systematically

assess the features of a candidate action: direct economic factors systemic factors (global benefits) cultural feasibility technological feasibility

in order to define prioritiesand to distribute resources across layers and actions


2. analysis by sub-domain sub-domains:

semantic interoperability in Electronic Healthcare records,

patient identifiers, eHealth messaging systems, Clinical guidelines business processes.

to work out:a. tables of preconditionsb. business implementation pathsc. concrete research tasks


2a. tables of preconditions use the reference taxonomy

as a check-list to enumerate the actionsthat are preconditionsfor the deployment of solutionsfor each sub-domain


2b. business implementation paths clarify the requirements

from the healthcare sectorand develop robust roadmaps,

to enable European industry to set up and follow a strategy for future product creation proceduresbased on innovative technologies, and

to be competitive in international markets


2c. concrete research tasks from the roadmaps, work out the gaps

requiring specific research efforts to drive RTD plans

for the research institutes and academia to suggest European collaboration

on innovative solutionsamong deployment programsacross Member States


3. synopsis and recommendations produce a synopsis of the methodology

and of the criteria developed during the RIDE project, as reference material for the production of new roadmaps

produce a set of recommendationsfor developers of national and regional roadmaps


thanks !

contact: Angelo Rossi Mori [email protected]

cnr-itbride workshop, brussels 2006-12-08 policies and roadmaps for semantic interoperability in the...

Documents

cnritbride workshop

cnritb slide

roadmap slide

research community slide

explanatory framework

adequate policies

documentbased approach

ehealth unit